Provider Demographics
NPI:1710200480
Name:GHC
Entity Type:Organization
Organization Name:GHC
Other - Org Name:GENESIS HOME CARE LINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-843-0030
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38732-1888
Mailing Address - Country:US
Mailing Address - Phone:662-843-0030
Mailing Address - Fax:662-846-0833
Practice Address - Street 1:700 E SUNFLOWER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:MS
Practice Address - Zip Code:38732-2726
Practice Address - Country:US
Practice Address - Phone:662-843-0030
Practice Address - Fax:662-846-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00185314Medicaid